The present invention relates to a method and apparatus which is used to simultaneously perform mechanical circulatory assistance and percutaneous transluminal coronary angioplasty ("PTCA") during periods of hemodynamic instability through a single femoral puncture site. More particularly, the invention consists of a intra aortic balloon pump catheter ("IABP") that is capable of receiving a coronary angioplasty guiding catheter, which in turn, receives and guides an angioplasty balloon catheter for performing PTCA.
Historically, often during periods of hemodynamic crises, a patient will typically require immediate coronary intervention through PTCA in order to remove the coronary blockage. In addition, to decrease the risk of the angioplasty procedure, simultaneous use of an IABP stabilizes the hemodynamic instability by providing augmented diastolic pressure. Moreover, recent medical data suggests that continued use of the IABP after PTCA will decrease the abrupt closure rate.
However, the present state of the art is such that both procedures (IABP and PTCA) typically need to be performed at the same femoral puncture site. For example, to place and operate an IABP, the common practice is to first gain access to the circulatory system at either the right or left femoral artery and to then work the IABP up to the descending thoracic aorta just distal to the left subclavian artery where it is then operated. Similarly, when performing PTCA, the common practice is to also first gain access for an angioplasty guiding catheter at either the right or left femoral artery and to then work the guiding catheter up to the appropriate coronary ostium. Once the guiding catheter is properly positioned, an angioplasty balloon catheter is then inserted into a lumen of the guiding catheter and positioned at the stenosis for the removal of the blockage.
This competition for the same femoral access site leads to difficulties in performing both operations simultaneously, since once an IABP is placed at a femoral site, no other intervention, such as PTCA, can be performed at that puncture site. Because of this limitation, practitioners must often chose to perform one procedure first, depending upon the situation, and then follow with the other procedure afterwards.
Alternatively, both procedures have been performed by using two operators. This is done by having one operator perform PTCA at one femoral puncture site, while another operator is placing an IABP at the opposing femoral puncture site. However, this type of procedure is not always an option due to the availability of practitioners or the blockage of on of the femoral sites.